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1417841909 NPI number — SERGE ANDREYEFF

NPI Number: 1417841909
Health Care Provider/Practitioner: SERGE ANDREYEFF

Information about “1417841909” NPI (SERGE ANDREYEFF) exists in 1417841909 in HTML format HTML  |  1417841909 in plain Text format TXT  |  1417841909 in PDF (Portable Document Format) PDF  |  1417841909 in an XML format XML  formats.

NPI Number : 1417841909 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417841909",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANDREYEFF",
    "FirstName": "SERGE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5601 MINKS POND RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BUSHKILL",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "18324-7623",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1309 COFFEEN AVE STE 1200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHERIDAN",
    "PracticeLocationAddressStateName": "WY",
    "PracticeLocationAddressPostalCode": "82801-5777",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "201-388-8989",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/07/2025",
    "LastUpdateDate": "06/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "X",
    "Gender": null,
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "F355947",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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